Trusted Health Plan™ strives to deliver our local Washington DC providers all the resources they need in order to assist them in providing most efficient and effective treatments. The list of authorization and request forms below is meant to assist you with that process. If there is a form that you feel other providers would find useful to access on this page, please contact us at 202-821-1145.

Urgent concurrent Authorization decisions will be made within 24 hours of receipt of request for services. Oral notification will be made within 24 hours of the decision.

Urgent Expedited Pre-service Authorization decisions will be made within 72 hours of receipt of the request for services with a possible extension of up to 14 calendar days. Oral notification will be made within 24 hours of the decision.

Standard Non-Urgent Preservice Authorization decisions will be made no later than 14 calendar days of receipt of request for services, with a possible extension of up to 14 calendar days. Oral notification will be made within 24 hours of the decision.

Post service Authorization decisions, as expeditiously as the member's health condition requires and no later than 14 calendar days of receipt of the request for services with a possible extension of up to 14 calendar days. Oral notification will be made within 24 hours of the decision.

What services require Prior Authorization?

The majority of services offered by THP do not require a Prior Authorization. Wellness care and diagnostic services (such as screenings and labs) require no prior plan notification. Services that do require a Prior Authorization are consistent with other plans. These services include, but are not limited to:

Inpatient and Outpatient Services

Rehabilitative Services

Nursing Home/ Skilled Nursing/Hospice Care

Major Surgery and General Anesthesia

Out of Network Providers

Non Formulary Pharmaceuticals

Emergency Services Notification

Emergency Services and Emergency Transportation do not require a Prior Authorization, but Plan Notification is encouraged as soon as possible.

Medical Authorizations

It is important to complete all relevant information on the Prior Authorization Form. Prior to sending your requests, please be sure that elegibility is checked. Requests will not be processed if they are missing the member number, clinical information, CPT, ICD-9 codes and/or Physician Signatures.

Pharmaceutical Authorizations

Obstetrical Notifications

Pregnancy care does not require a Pre-Authorization. However, plan notification of OB services is required. OB care and services will be coordinated by a Trusted OB Case Manager. You may fax this OB Authorization form to UM at 202-821-1098.

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TRUSTED Health Plan, also known as THP is the premier Managed Healthcare Organization in
Washington D.C.. THP is charged with managing care for Medicaid and Alliance members. TRUSTED
HP also offers online access to Providers of Healthcare Service to Medicaid and Alliance Member via Portals
to monitor claims, verify eligibility, become a TRUSTED HP provider, check Medicaid or Alliance Formulary
and THP Member Pharmacies. We look, live and are the District of Columbia and are located in Anacostia
east of the river so that we can serve the people of wards 7 and 8.